Text: Marjolein de Jong | Photo: David Meulenbeld | September 14, 2022
Sijbrandij has been researching the effects of traumatic experiences for over twenty years. The “lay therapy” is currently being used in collaboration with VU University Amsterdam to help refugees from Ukraine.
Can you tell us a little about the therapy you’ve been researching?
“Thistherapy, also known as Problem Management Plus (PM+), was developed by the World Health Organization for people in refugee camps and conflict zones. In those areas, there are often few or no psychologists, even though the need is great. I came across this therapy during one of my work visits and thought: couldn’t we use this for the large group of Syrian refugees in the Netherlands?
What makes it special is that, after a one-week course, anyone—with or without psychological training—can provide this treatment. These are often ordinary people who may also have fled their homes. The results are positive: help can be provided in the client’s own language—without an interpreter—and we often hear from clients that people from the same culture, or who have gone through the same experiences, understand much better the challenges refugees face.’
What exactly does the method entail?
“The ‘helpers,’ together with the client, identify all the problems over the course of about five sessions and distinguish between solvable and unsolvable problems. These can be all sorts of things. Someone might be afraid to take their child to school, or feel lonely—there are ways to address that. Look, we can’t do anything about the fact that someone’s asylum status isn’t yet known, but we can offer relaxation exercises to help cope with that stress. So the problems are resolved—where possible—but just as important: people are encouraged to take control of their own lives again. They literally start moving forward.”
'I think many people believe that refugees have been through so many terrible things that they’ll never recover from them.'
How does this study differ from earlier, similar methods?
“This is the first study of a low-threshold intervention for refugees that we actually know to be effective. Earlier methods have not been tested, or only minimally so. We followed a group of Syrian refugees for three months and compared the subgroup that received PM+ treatment with a control group, without knowing which group had received which treatment. We saw positive results in terms of improvements in depression, anxiety, post-traumatic stress symptoms, and overall functioning.
This gives us hope. I think many people assume that refugees have been through so many terrible things that they’ll never recover. Yet we’re seeing that with a small intervention, we can give a large group of people the tools they need to cope with stress. And if you’re not seeing images of what you’ve been through all day long, you also have more room to build a fulfilling life in the Netherlands.”
Could something go wrong because the “helpers” don’t have a medical background?
"Every step is laid out very precisely in a protocol: how should you respond to this, and what should you say in that situation? Sometimes helpers end up giving people advice based on their own experiences, or they tell the people they’re helping that they should pray a lot. You can’t completely prevent that. But we train people on how to conduct themselves as care providers and where the boundaries of care lie. In addition, there are two hours of supervision by psychologists every week.'
'Many treatment methods are simply translated, but research shows that cultural adaptation increases their effectiveness'
Groups of refugees have recently been sleeping outdoors in Ter Apel on a regular basis. How do you view this from your perspective?
“This situation is extremely harmful to these people’s mental health. Often, they’ve already been exposed to a great deal of hardship on their way to the Netherlands. Then they arrive here thinking they’ve finally made it, only to face even more uncertainty and stress. I’m very concerned about this. Refugees have a right to quality mental health care.”
Can the protocol be applied to every refugee from every country?
“We adapt the protocol culturally, so in principle, yes. Many treatment methods are simply translated, but research shows that cultural adaptation increases their effectiveness. The way Syrians talk about mental health issues—the words they use to describe them and what they perceive as problematic or stigmatizing—differs from the perspectives of people from, say, Ukraine. But of course, we can’t fully help everyone. There will always be exceptional cases that require more therapy.'
Can you tell us a bit about how this method is currently being used for refugees from Ukraine?
“We’ve set up a network at VU University Amsterdam for refugeesfrom Ukraine. Psychologists who have fled Ukraine can be deployed to help other refugees. They cannot yet practice as psychologists in the Netherlands. We’ve just started training the first group of psychologists, who will in turn train “helpers.” So it’s still in the early stages. But by chance, the protocol had already been translated into Ukrainian before the war broke out. A blessing in disguise.'
